Less Aggressive IVF Protocol Cuts Multiples, Retains Live Birth Rate

A less aggressive in vitro fertilization protocol results in roughly the same rate of pregnancies leading to term live births as do standard methods, but with decreased multiple pregnancy rates and overall cost, according to Dutch researchers.

The cumulative 1-year proportion of pregnancies producing term live births was 43% in 205 women who underwent the less aggressive IVF protocol, compared with 45% in 199 women who underwent standard treatment, the investigators reported.

The women were randomized to one of two IVF strategies: standard ovarian stimulation with a GnRH agonist long protocol and the transfer of two embryos (standard treatment) or mild ovarian stimulation with GnRH antagonist cotreatment and single embryo transfer (what the researchers termed “mild” treatment).

The women were aged younger than 38 years and either had no previous IVF treatment or had borne a healthy child after previous IVF treatment, wrote Dr. Esther Heijnen and her colleagues at the University Medical Center in Utrecht, the Netherlands (Lancet 2007;369:743-49).

High-quality embryos that were not transferred were cryopreserved and thawed for transfer in a subsequent unstimulated cycle before the start of a new IVF treatment cycle. The average number of treatment cycles was 2.3 in the mild treatment group and 1.7 in the standard treatment group. Overall, there was no significant difference in discomfort between the groups, despite an increase in the average number of IVF cycles for the mild treatment group.

The proportion of multiple births per couple during 1 year of treatment was significantly lower with mild treatment (0.5% vs. 13%).

Despite a greater average number of cycles in the mild treatment group, total costs of IVF treatment per couple (regardless of whether pregnancy resulted) were significantly lower with less aggressive treatment.